中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2013年
11期
739-743
,共5页
孙希印%吴起嵩%耿振宏%李青%王琳琳%李新功
孫希印%吳起嵩%耿振宏%李青%王琳琳%李新功
손희인%오기숭%경진굉%리청%왕림림%리신공
胃肠道间质肿瘤%肿瘤,多原发性%诊断,鉴别
胃腸道間質腫瘤%腫瘤,多原髮性%診斷,鑒彆
위장도간질종류%종류,다원발성%진단,감별
Gastrointestinal stromal tumors%Neoplasms,multiple primary%Diagnosis,differential
目的 分析与消化道癌并发的胃肠道间质瘤(GIST)的临床病理特点并探讨其处理原则.方法 复习山东省东营市人民医院、胜利油田中心医院、胜利石油管理局胜利医院3所医院2002年1月至2008年12月收检的113例GIST病例,观察并发胃肠道癌病例(19例)的临床病理特点,与未并发胃肠道癌的病例(94例)进行比较.结果 113例中并发胃肠道癌者19例,占16.8％.其中男11例,女8例,男女之比为1.38∶1.00.年龄43 ～ 66岁,中位年龄57岁.19例中位于食管下段者5例,位于胃壁14例,肿瘤直径0.6 ～ 3.8 cm,平均(1.91±0.92)cm,3例有轻度异型性,其余无异型性.核分裂象数0 ～ 4/50 HPF,平均(0.74±1.07)/50 HPF,Ki-67阳性指数0～ 7.72％,平均(2.51±2.20)％.并发癌瘤包括食管癌2例,胃癌17例.作为对照,未并发胃肠道癌者94例,男52例,女42例,男女之比为1.24∶1.00.年龄43 ～ 71岁,中位年龄55岁.79例发生于胃,10例位于肠,5例发生于食管.肿瘤直径2.4～15.5 cm,平均(5.42±6.17)cm.79例显示不同程度的异型性,12例具有高度恶性潜能.核分裂象数0 ～ 53/50 HPF,平均(3.78±10.22)/50 HPF.Ki-67阳性指数0 ～ 37.54％,平均(6.78±12.45)％.并发癌的GIST与未并发癌者比较,男女比值较高,瘤体平均直径较小,细胞异型性小,核分裂象数和Ki-67阳性指数均较低(分别为t’=2.809,P＜0.05;t’=3.095,P＜0.05).结论 16.8％的GIST并发癌.与癌并发的GIST多数没有特殊临床症状,多因癌手术后大体检查发现,其增殖活性显著低于未并发癌的GIST,多数不需要针对性治疗,当肿瘤具有恶性指征时采用恶性GIST治疗规范.
目的 分析與消化道癌併髮的胃腸道間質瘤(GIST)的臨床病理特點併探討其處理原則.方法 複習山東省東營市人民醫院、勝利油田中心醫院、勝利石油管理跼勝利醫院3所醫院2002年1月至2008年12月收檢的113例GIST病例,觀察併髮胃腸道癌病例(19例)的臨床病理特點,與未併髮胃腸道癌的病例(94例)進行比較.結果 113例中併髮胃腸道癌者19例,佔16.8％.其中男11例,女8例,男女之比為1.38∶1.00.年齡43 ～ 66歲,中位年齡57歲.19例中位于食管下段者5例,位于胃壁14例,腫瘤直徑0.6 ～ 3.8 cm,平均(1.91±0.92)cm,3例有輕度異型性,其餘無異型性.覈分裂象數0 ～ 4/50 HPF,平均(0.74±1.07)/50 HPF,Ki-67暘性指數0～ 7.72％,平均(2.51±2.20)％.併髮癌瘤包括食管癌2例,胃癌17例.作為對照,未併髮胃腸道癌者94例,男52例,女42例,男女之比為1.24∶1.00.年齡43 ～ 71歲,中位年齡55歲.79例髮生于胃,10例位于腸,5例髮生于食管.腫瘤直徑2.4～15.5 cm,平均(5.42±6.17)cm.79例顯示不同程度的異型性,12例具有高度噁性潛能.覈分裂象數0 ～ 53/50 HPF,平均(3.78±10.22)/50 HPF.Ki-67暘性指數0 ～ 37.54％,平均(6.78±12.45)％.併髮癌的GIST與未併髮癌者比較,男女比值較高,瘤體平均直徑較小,細胞異型性小,覈分裂象數和Ki-67暘性指數均較低(分彆為t’=2.809,P＜0.05;t’=3.095,P＜0.05).結論 16.8％的GIST併髮癌.與癌併髮的GIST多數沒有特殊臨床癥狀,多因癌手術後大體檢查髮現,其增殖活性顯著低于未併髮癌的GIST,多數不需要針對性治療,噹腫瘤具有噁性指徵時採用噁性GIST治療規範.
목적 분석여소화도암병발적위장도간질류(GIST)적림상병리특점병탐토기처리원칙.방법 복습산동성동영시인민의원、성리유전중심의원、성리석유관리국성리의원3소의원2002년1월지2008년12월수검적113례GIST병례,관찰병발위장도암병례(19례)적림상병리특점,여미병발위장도암적병례(94례)진행비교.결과 113례중병발위장도암자19례,점16.8％.기중남11례,녀8례,남녀지비위1.38∶1.00.년령43 ～ 66세,중위년령57세.19례중위우식관하단자5례,위우위벽14례,종류직경0.6 ～ 3.8 cm,평균(1.91±0.92)cm,3례유경도이형성,기여무이형성.핵분렬상수0 ～ 4/50 HPF,평균(0.74±1.07)/50 HPF,Ki-67양성지수0～ 7.72％,평균(2.51±2.20)％.병발암류포괄식관암2례,위암17례.작위대조,미병발위장도암자94례,남52례,녀42례,남녀지비위1.24∶1.00.년령43 ～ 71세,중위년령55세.79례발생우위,10례위우장,5례발생우식관.종류직경2.4～15.5 cm,평균(5.42±6.17)cm.79례현시불동정도적이형성,12례구유고도악성잠능.핵분렬상수0 ～ 53/50 HPF,평균(3.78±10.22)/50 HPF.Ki-67양성지수0 ～ 37.54％,평균(6.78±12.45)％.병발암적GIST여미병발암자비교,남녀비치교고,류체평균직경교소,세포이형성소,핵분렬상수화Ki-67양성지수균교저(분별위t’=2.809,P＜0.05;t’=3.095,P＜0.05).결론 16.8％적GIST병발암.여암병발적GIST다수몰유특수림상증상,다인암수술후대체검사발현,기증식활성현저저우미병발암적GIST,다수불수요침대성치료,당종류구유악성지정시채용악성GIST치료규범.
Objective To evaluate the clinicopathologic features of gastrointestinal stromal tumor (GIST) with synchronous carcinoma and the treatment principle.Methods Nineteen cases of GIST with synchronous carcinoma were collected from 113 cases of GIST from 2002 to 2008.The clinicopathologic features were studied and the expression of CD117,CD34,smooth muscle actin and S-100 protein were detected by immunohistochemistry using EliVision method.The expression of proliferation marker Ki-67 was also studied.GIST with synchronous carcinoma and those without carcinoma were compared.Results Nineteen cases (16.8％) of GIST with synchronous carcinoma were found,including 11 males and 8 females (male to female ratio 1.38∶ 1.00).The age of the patients ranged from 43 to 66 years (median age 57 years).Five of 19 cases were located in the inferior segment of esophagus and 14 were in the gastric wall.The diameter ranged from 0.6 to 3.8 cm [mean (1.91 ±0.92) cm].Three of 19 cases showed low grade dysplasia,and there was no dysplasia in the remaining 16 cases.The number of mitosis ranged from 0 to 4/50 HPF [mean (0.74 ± 1.07)/50 HPF].The Ki-67 proliferative index (number of Ki-67 positive cell/HPF) ranged from 0 to 7.72％ [mean (2.51 ± 2.20)％].The synchronous carcinomas included two esophageal carcinomas and 17 gastric cancers.In contrast,patients of GIST without carcinoma included 52 males and 42 females (male to female ratio 1.24∶1.00).The age of patients ranged from 43 to 71 years (median age 55 years).Seventy-nine of the 94 cases were located in the stomach,10 were in the intestine and 5 were in the esophagus.The diameter ranged from 2.4 to 15.5 cm [mean (5.42 ± 6.17) cm].Seventy-nine of the 94 cases showed variable degrees of dysplasia,and 12 cases were of high malignant potential.The number of mitosis ranged from 0 to 53/50 HPF [average (3.78 ± 10.22)/50 HPF].The Ki-67 proliferative index ranged from 0 to 37.54％ [mean (6.78 ±0 12.45) ％].Comparing these two groups,the male to female ratio of GIST with synchronous carcinoma was higher than that of GIST without carcinoma.The average diameter of GIST with synchronous carcinoma was smaller than of those without carcinoma.The number of mitosis and Ki-67 proliferative index of GIST with synchronous carcinoma were significantly lower than those without carcinoma (t' =2.809,P ＜ 0.05; t' =3.095,P ＜ 0.05,respectively).Conclusions Sixteen point eight percent of GIST may be associated with synchronous carcinoma.There are no special clinical symptoms in most of GIST with synchronous carcinoma,as these GIST are usually incidental findings.The Ki-67 proliferative index of GIST with synchronous carcinoma is significantly lower than that of GIST without synchronous carcinoma.Most GIST with synchronous carcinoma can be treated by the standard treatment for the accompanying carcinoma,and do not require specific additional treatments.
